Dear Sir,

As a Bermudian health service provider, I want to share some of my concerns in regards to the single-payer insurance plan that the Ministry of Health is proposing.

From what I understand, the Government would like everyone to be covered by the same policy administered under one roof.

If a person wants more coverage than the government policy provides, they can purchase additional coverage from any of the private health insurance providers.

Before last week, the meetings I had attended spoke only to the ministry’s objectives and challenges; objectives I’m certain we can all agree on — healthcare for all with an emphasis on prevention, and slowing down the ever-rising cost of healthcare.

In meeting with the dental service providers last week, the minister and her officials made it clear that they were moving the country to a single insurance provider.

The way they were speaking, it sounded like the train had already left the station.

At this stage, the ministry is asking us what dental services should be included in a basic benefits package, while keeping in mind the objectives of universal access and prevention.

There is no simple answer. Basic care for a healthy individual is different than basic care for a sick individual.

The ministry is aiming to slow down the rising cost of healthcare. This is a worthwhile goal, but to achieve it much needs to be known, such as what is being spent and on whom, and whether treatments are matching diagnoses for favourable outcomes.

I’m pleased that there has been discussion about patient identifier systems that can help to track patient information.

This would be a good starting point — seeing what is really going on and where problems truly lie. Sort of like balancing your chequebook before you go shopping.

So that is background. The big question for me is why the Government is scrapping the existing system, which is working for about 45,000 people — about 70 per cent of the island’s population. Most of us pay more to get our hair and nails done than we do in health provider copays.

It’s not pocket change, but most health management co-pays are doable for most of us.

I am assuming the concern that’s driving the ministry’s planned changes is for the 30 per cent of the population for whom the system does not work.

So why not discuss how we can get them on board? Why not fix the parts of the system that are not working for uninsured or underinsured persons.

The move to a single-payer system for all raises great concern for the following reasons:

• The anticipated higher cost of supplemental insurance, whether it is purchased or not. If it isn’t purchased, patients may not be able to afford needed care beyond basic care. If it is purchased by fewer and higher-risk individuals, which is likely, the insurance models will run up the cost of the policies

• When the Government passed legislation that health providers could no longer ask for full payment at time of service, it also passed legislation requiring insurance providers to pay within 30 days so as not to affect cashflow for health providers’ business operating expenses

That was a real concern at the time. Some of the insurance companies are good at reimbursing providers in a timely manner; others not so. Reimbursements from government agencies have proved to be inconsistent.

As a result, we count on the insurers with timely reimbursement practices for our needed cashflow, which is crucial for meeting our ongoing business costs such as salaries and supplies.

Having to depend on one payer in a single-payer system, whose record for timely reimbursements is unreliable, is a cause for concern

• Those services that may be considered “basic care”, which this plan seems to want to cap fees for, are also the services that cover a considerable amount of the daily operational expense of running a health services clinic. Capping fees for “basic care” diminishes available resources to provide care, and this runs counter to the ministry’s goals of prevention, education and good quality care. The ministry’s goals require more resources to deliver, not less

• A universal-payer system gives the ministry too much control, and the ramifications of unreliable reimbursements on capped fees could literally shut down a health provider overnight. The ability to receive timely payment for our services is essential to the continuing delivery of those services to our patients. To place the whole system into the hands of one payer is, again, serious cause for concern

Bermuda’s overuse of healthcare is complicated because of population size, genetics and lifestyle. Focusing our efforts on these areas, as well as the 30 per cent, seems more reasonable than trying to fix a whole system that is working for 70 per cent of the population.

RONDA JAMES, DDS

Paget